Controversies in the Impact of Diet on Alzheimer Disease Prevention, Management
This podcast series aims to highlight the science, psychology, and strategies behind the practice of dietetics. Moderator, Lisa Jones, MA, RDN, LDN, FAND, interviews prominent dietitians and health professionals to help our community think differently about food and nutrition.
In this podcast episode, Lisa Jones, interviews Amylee Amos, PhD, RDN, IFMCP, about the key arguments and controversies surrounding specific diets in relation to Alzheimer disease prevention and management, and how dietitians can navigate controversies to provide the best guidance for their clients. This is episode three of a four-part podcast series on Alzheimer disease.
Additional Resource:
- Amos Institute. Accessed October 5, 2023. https://amosinstitute.com/our-founder/
- The Institute for Functional Medicine. Accessed October 5, 2023. https://www.ifm.org/
- KetoFLEX 12/3. Apollo Health. Accessed October 5, 2023. https://www.apollohealthco.com/ketoflex-12-3/
Listen to episode one of this four-part podcast series here.
Listen to episode two of this four-part podcast series here.
Listen to episode four of this four-part podcast series here.
TRANSCRIPTION:
Speaker 1:
Hello and welcome to Nutrition411: The Podcast. A special podcast series led by registered dietitian and nutritionist Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions or Consultant 360.
Lisa Jones:
Well, we are here in episode three and I have the privilege of talking to Dr. Amylee Amos.
Amylee Amos:
Thank you. Hi.
Lisa Jones:
Yes, hi. How are you today?
Amylee Amos:
I'm great. How are you doing?
Lisa Jones:
Good. We are talking today about exploring key topics and debates in dietetics. But first I want to go back to our most recent episode where we covered how dietitians can effectively translate the latest research on diet and Alzheimer's disease. Amylee, if you had to sum up that conversation in one or two sentences, what would you say were the key takeaways from that episode?
Amylee Amos:
Okay. So I think the key takeaways were, as dietitians or clinicians in general, it's our responsibility to stay up with the research on any population that we are going to be treating. And the way that we do that is to look at the available literature as a whole. And that means looking at nutritional epidemiology, looking at centenarian studies, looking at clinical trials, looking at everything and synthesizing for ourselves, all of that available data before we come up with any sort of clinical intervention.
Lisa Jones:
Which is an excellent plan. And I like your word synthesis. So to me, synthesizing is a key takeaway too.
Amylee Amos:
Yeah, absolutely. And it's easier said than done. It's easy to say, "Okay, just read all the research and synthesize it." That's very challenging to do. We spend our careers learning how to do that, but it's also a responsibility. That's something that we have to do if we want to treat that population, which is why many RDs choose to specialize in certain things because it makes it a little bit easier when you're just reviewing the literature of a specific disease state or patient base or something like that.
Lisa Jones:
Yes. Exactly. So true. And the other thing, too, right now with that whole artificial intelligence, people are like, there's probably some sort of AI for that, but there isn't. Because I don't know if you've ever played around in it, you can type in research and a lot of times it's not always accurate. So that is definitely not the place to synthesize your research.
Amylee Amos:
Yeah, I think there's... Obviously, that's a different conversation, but there's a place for AI, but we have to be very careful with how we use it right?
Lisa Jones:
Yes. Exactly. All right, yeah, that's a whole different episode. But back to what we were talking about. We were talking about, my question for you, what are the key arguments and controversies that surround specific diets in relation to Alzheimer's prevention and management? That's my first question.
Amylee Amos:
Okay. So I would say, probably, the first controversy that we should just get off the table is there are still some people who don't believe that diet plays any role in cognition or in Alzheimer's cognitive decline. Those people just haven't stayed up with any of the research. So I would say, that's the main thing to get off your plate if you're a clinician and you come into contact with someone like that, the available evidence is overwhelming to show that diet does play a role.
Now, that's not to say that it plays the entire role. We know that with all complex chronic diseases, which includes Alzheimer's disease, it's multifactorial etiology. So that means that we need to address every single modifiable lifestyle factor that we can. And if each of those contributes a modest portion to the whole, we can make huge progress. And we know that with nutrition, it's not even modest. It's a huge portion.
So that's the first kind of controversy is that there are still some allopathically trained clinicians out there who believe in this kind of genetic determinism model of Alzheimer's disease, which is outdated. So that would be the first one. The second big controversy I would say is the intake of saturated fat with regards to a diet to promote brain health and to improve cognitive function. So as I mentioned in one of our last episodes, there is a diet known as the KetoFLEX 12/3, and this is a diet that helps the individual get into a very mild ketosis. And by mild, I mean anywhere from 0.5 to four millimoles of beta hydroxybutyrate. So this is a very low level of ketosis, and I'm sure all the listeners know that something like coconut oil, MCT oil, that's very effective in helping an individual have a slightly higher level of ketones in their blood.
So a lot of people are out there pushing very, very high saturated fat diets. And unfortunately, while that is, I think helpful sometimes in the short term, it's not helpful in the long term because when we dramatically increase the intake of saturated fat, we see a real spike in cardiovascular disease risk. Now, there's also a lot of controversy just in that statement alone, and that's because the risk of cardiovascular disease as it relates to saturated fat intake follows a sigmoidal curve, like a kind of an S-shape curve, which means that there is a critical threshold that has to be passed before we see that increased risk. So if you are below that threshold, which appears to be somewhere along the lines of like eight, nine, 10% of calories from saturated fat in the diet, as long as you're below that, you're fine. And that's why there are kind of some confusing studies that show no differences between someone who's on very low levels versus low levels or somebody who's at moderately high levels above that 10% threshold or extremely high levels.
Those are kind of the same. It's just about this critical threshold. So I would say the saturated fat controversy is still there, even though I would argue that the research is quite clear that we need to lower our saturated fat intake below that threshold. And you can do that and still create a state of mild ketosis that I just described. So again, it's all about the nuance. When we use words like ketosis, and ketogenic, that tends to, it's certainly in the layperson's mind, mean a lot of saturated fat, and it doesn't have to. We can create that state of very mild ketosis using a fully plant-based approach. I don't mean vegan or vegetarian necessarily, although that's a choice that an individual can certainly make, but you can do it with mostly plants and using plant sources of fat. So that's a really big controversy in this field as well.
Lisa Jones:
Yes, it definitely is. The other thing I'm thinking, as I was listening to you talk about it too, is that makes the case stronger for making sure that you're working with a dietitian that can help you with the planning. Because if you're kind of like somebody that just doesn't have anybody like a dietitian on your team helping you navigate through this and you're just looking up some app or trying to track it that way with yourself, that's where you kind of go over that threshold that you were talking about that then becomes not helpful in the long term.
Amylee Amos:
Absolutely. And you bring up this point of we have to be really careful of when someone's out there and just winging it on their own, trying to do their best. And then perhaps let's say that they're doing something that's not in their best interest in terms of health span and longevity, but they feel better in the interim. And we hear this all the time with people on really some crazy fad diets out there, "Well, I feel better. My weight has come down, my blood pressure has come down. How could this be bad." Someone who's eating, for example, just tons of saturated fat, tons of animal products, how do we then tell them that what they're doing is wrong when they're telling us as the clinician that they feel much better? And when I hear those kinds of scenarios from people, I refer back to smoking. Smoking often makes people feel better in the short term.
It helps with stress, it helps curb your appetite, so you can sometimes lose weight. If you lose weight, sometimes your blood pressure goes down, sometimes certain other levels come down, and different things in our biochemistry can come down too. Just because all of that occurs does not mean that smoking is good for us in the long run. And so that's kind of an extreme example of what we're seeing with diet. Just because someone does something that in the short term might make them feel good, does not mean that they are consuming a diet that's going to help them in the long term. So that's where we as clinicians need to understand all of that research and be able to help guide them in order to create a diet that's going to make them feel good in the short term and the long term.
Lisa Jones:
And you bring up a good point, but not good enough to make me start smoking though.
Amylee Amos:
Well, exactly right? I mean, no, you'd be crazy to want to start smoking because you heard that it might make you feel better in the beginning. That doesn't mean on any level that anyone should ever recommend that for an individual right?
Lisa Jones:
Exactly. But that was-
Amylee Amos:
It's just a good way of... Again, it's an extreme example, but it kind of highlights just how crazy it would be for us to encourage someone to do something just because they're feeling a little bit better.
Lisa Jones:
Yes. But that's such a great example that you bring up though, because this is what's happening all the time. How many times did they read, there's something in the media or somebody did a TikTok video and they're like, "Oh, I heard about this diet and this person lost 70 pounds and something crazy like three months and I'm going to start it," and they don't contact a dietitian, and they started this diet without any regards to what it's really about.
Amylee Amos:
Exactly. So just because it might have one benefit, weight loss or whatever it might be, doesn't mean it's a good thing.
Lisa Jones:
I think that could be true with anything. We can have a whole nother episode on just that alone. Right?
Amylee Amos:
Right. You're absolutely right. So I think that's maybe also... that is a controversy in and of itself that we have to kind of, as clinicians be cognizant of that when we're talking to someone. While it's important to be intuitive and for someone to trust their own body, we also have to use the available evidence to help show and guide with regards to what is the best diet and lifestyle for an individual in the long term, assuming that someone's goal is longevity, health span and longevity.
Lisa Jones:
Yes. And I mean, I think most people should have that as their goal, but that's just my personal opinion.
Amylee Amos:
I mean, yeah, I hate to say everyone. Can't make blanket statements, but I would say for most people, the vast majority, that is the goal.
Lisa Jones:
Yes. And then that leads me to, you kind of already touched on a little bit, but how can clinicians really navigate these debates and then provide the best guidance for their clients? What would you say to that?
Amylee Amos:
Yeah, so I think if you're going to engage in a thoughtful conversation, you need to make sure that you're well-versed in the topic. So I think where it gets really tricky is when, and I think everyone has fallen victim to this at some point, certainly, I have too, but when we start engaging in a conversation and we're not 100% certain of all of the nuance involved, we do a detriment to our profession and to the patient that we have in front of us. Nothing in nutrition is as black and white as we want it to be. There's always nuance there. So we have to kind of take a step back from the hyperbolic language that is often used not even by dietitians, but by just people out in the social media world who are self-proclaimed experts in the field.
We, as educated experts, need to avoid the hyperbolic language, and we need to talk with all of the nuances, even though that's not as sexy as these strong black-and-white statements. I think that's really important. And if you're not certain, it's okay to say that you don't know. We don't know everything. Even the smartest dietitian out there, whoever they are, they don't know everything. And that's all right. So it's okay for us to tell a patient or a client, "I'm not sure. That's not my area of expertise, but either I can find out for you or I can send you to someone who does know."
Lisa Jones:
Yes, yes. A big yes end to that, because I was just about to say, that's one of the things I said in the past like, "I don't know the answer, but I know somebody who might, and here's the referral for you."
Amylee Amos:
Exactly. I think that's powerful.
Lisa Jones:
Yeah. I mean, the first time you say it, in all honesty, it kind of feels like, "Oh, I'm saying I don't know, or should I be knowing this answer?" But you say it anyway because you don't know. You don't want to start improvising something you don't know what you're talking about, because you're right, it goes back to being a detriment to your profession and the others that you work with so...
Amylee Amos:
Right.
Lisa Jones:
Yes, keeping that in mind. Once you do your first one, then every other... I don't know after that is fine.
Amylee Amos:
Yeah, I agree. And I think if I put myself as the patient there, I would much prefer my doctor or health practitioner, whoever it is, tell me that they're not sure and they're going to find out or send me to someone who is sure, rather than just kind of coming up with something off the top of their head. I think that establishes trust between patient and practitioner, which is wonderful for your long-term relationship with that patient.
Lisa Jones:
Exactly. And that reminds me of the one time I was in my doctor's office and he had to go look something up because he's like, "I don't know the answer to that. I'm going to look it up." And I sat there with him while I looked it up, and then he called a colleague of his, and they knew the answer, but that made me trust him even more. And then I had this 20-year relationship with him until he moved to another state where obviously I couldn't follow him to the other state.
Amylee Amos:
Right. But how nice to see that.
Lisa Jones:
I guess that'd be weird. Well, anything else that you want to contribute to this conversation about debates?
Amylee Amos:
Yeah, I mean, there's a lot in this area, but it's hard when we get in the weeds with these kinds of things like trying to remember our own bias because everyone has some sort of bias. We're human beings, and so as long as we are all aware of our own biases when they come up with regards to diet, that's how we can then make the most objective calls possible. I think it's much scarier when we are faced with the individual who says that they're completely unbiased. That just isn't possible. So as long as we're able to come to terms with what our own biases may be, and then do our absolute best to put them aside, I think the awareness of it is essential. And then trying to put it aside, being upfront with what they might be, that's a really important step when you're getting into one of these debates about one of these controversies.
Lisa Jones:
What great advice, and thank you for sharing all your wisdom on this episode with us.
Speaker 4:
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